從解約案例來檢視日本公立醫院PFI之課題與限制

Examine the Difficulties and Limits of Public Hospital PFI in Japan through Terminated Cases

在日本，PFI被視為是九○年代後期一種新的社會基礎設施整備方式，事業範圍分佈廣泛，但在僅有對外正式營運的5件醫院案例中，卻有2件在經營不到三年的時間內即提前解約，屬於該國實施PFI較不成功的事業領域，因而引發作者的研究動機，欲藉由兩起解約案例來檢視日本公立醫院PFI的課題與限制。研究結果發現，有鑑於地方財政的壓力與區域醫療公共性的雙重考量，可以將「引進民間力量」視為是「手段」，用以達到確保區域醫療公共性的這項「目的」。因此，作者認為PFI的成功與否應考慮（1）市場生態；（2）事業性質；（3）業務範圍等三項要件。在此三項要件無法完全滿足的情況下，現階段PFI未必是醫療領域改革的最佳選項。另外，在進行公立醫院改革時，可以考慮根據醫院所在將公立醫院區分為都會型公立醫院和偏遠型公立醫院，後者因位於偏遠地區，病患來源較少，且醫療資源相對缺乏，在確保民眾醫療公共性與經營效率雙重考量下，在民營對象的選取上可考慮將教學醫院列為優先選項，因為教學醫院本身是教育事業體，較能站在公部門的立場思考，但為彌補民間業者因提供政策醫療等公眾衛生服務所產生的虧損，政府仍需藉由補助金制度來增強其供給區域醫療服務之意願。

In late 1990s, PFI is regarded as a new way of constructing basic social infrastructures in Japan, the PFI projects cover a wide range of areas, but 2 out of 5 formally operating hospital projects resulted to failure and termination within 3 years. Public Hospital becomes a less successful field when implementing PFI, thereby triggers the author's motivation to look further into the study field and examine the difficulties and limits of public hospital PFI in Japan through 2 terminated cases. Study results shows that, in order to decrease local financial pressure and strengthen the publicity of regional medical, introducing private investment could be a 'mean', to ensure the 'goal' of achieving the publicity of regional medical. Therefore, the author believes that the success of PFI is related to 3 factors: (1) Ecological Environment of Markets(2) BusinessFeatures (3) Business Scope. If the 3 factors could not be fully satisfied, then PFI may not be the best option for medical reformation at the meantime. Moreover, when implementing medical reforms, we could consider categorizing public hospital into 2 kinds: metropolitan hospitals and remote area hospitals, the latter ones have fewer patients, and without sufficient medical resources comparing to the former ones. To ensure the publicity of medical service and efficiency, we can choose teaching hospitals as top priority for privatization, because teaching hospitals themselves derive from educational industry, they could look at situations from a public sector perspective. However, to compensate the loss of private industries for providing medical and public health service, the government should set up a grant system to enhance their motivation of offering regional medical service.